Healthcare Provider Details

I. General information

NPI: 1366374415
Provider Name (Legal Business Name): BINEETTA PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14591 ASHTON DR
SHELBY TOWNSHIP MI
48315-4902
US

IV. Provider business mailing address

14591 ASHTON DR
SHELBY TOWNSHIP MI
48315-4902
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-0995
  • Fax:
Mailing address:
  • Phone: 248-761-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704360653NSA2609I
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: